Whitening Effect of Salicylic Acid Peels in Asian Patients

BACKGROUND: Patients with skin of color demand treatment modality suitable for their skin. Salicylic acid peel has effectiveness for both of acne and postinflammatory hyperpigmentation that are common in patients with skin of color. OBJECTIVE: To assess the whitening effect of salicylic acid peels in Asian patients with acne objectively by the colorimetric method. METHODS: Twenty-four healthy adult patients with acne participated voluntarily in the study. Any other systemic and topical acne treatments were prohibited. They had undergone full-face peels with 30% salicylic acid in absolute ethanol bi-weekly for 3 months. Colorimetric changes of the face were recorded with reflectance spectrophotometer. RESULTS: Paired comparisons with pretreatment CIE L*a*b* showed abrupt descent of L* value after first peel (p=.0286). Then there was continued increase of mean L* value, even though the final L* value did not reach a statistically significant level. The mean a* value decreased continually, and the a* values recorded after the second, third, fourth, fifth, and final peel showed significantly lowered levels (p=.0027, .0005, <.0001, <.0001, <.0001). CONCLUSION: Salicylic acid peels are beneficial in whitening the face of Asian patients with acne. The whitening effect would be an important factor in choosing the superficial peeling agent for them.     

超分子水杨酸化学焕肤术联合黄金射频微针治疗毛孔粗大的效果

目的 探究超分子水杨酸化学焕肤术联合黄金射频微针对毛孔粗大的临床疗效。方法 选取 2022年12月-2023年12月于我院就诊的60例毛孔粗大患者作为研究对象,随机分为对照组（n =30）和试验 组（n =30）。对照组给予黄金射频微针治疗,试验组在对照组基础上联合超分子水杨酸焕肤术治疗,比较两 组面部毛孔状态、Face-Q量表评分、不良反应发生情况。结果 两组治疗后毛孔评级、毛孔计数绝对值均低 于治疗前,且试验组低于对照组（P ＜0.05）;两组治疗后面部整体满意度评分、心理功能评分均高于治疗 前,且试验组高于对照组（P＜0.05）;两组不良反应发生率比较,差异无统计学意义（P＞0.05）。结论 超分 子水杨酸化学焕肤术与黄金射频微针联合应用于毛孔粗大患者中,可以改善患者面部毛孔粗大问题,提升 患者对面部的满意度,且该联合治疗方式安全可靠,值得应用。     

Salicylic Acid Peels for the Treatment of Acne Vulgaris in Asian Patients

BACKGROUND: Salicylic acid peels have been introduced as a useful modality in acne treatment. Few studies have examined its efficacy and safety, especially in darker skin. OBJECTIVE: To assess the efficacy and safety of salicylic acid peels as a treatment for acne vulgaris in Asian patients. METHODS: Thirty-five Korean patients with facial acne were treated with 30% salicylic acid peels biweekly for 12 weeks. Lesion counts and Dr. Cunliffe's score were assessed by a blinded evaluator. Safety assessments and patient's evaluations were also recorded. RESULTS: Both inflammatory and noninflammatory acne lesion counts were decreased in proportion to the duration of treatment. Dr. Cunliffe's acne grade was statistically significantly decreased after treatment. The side effects were tolerable in most cases, and all patients were pleased with their peel results. Stratum corneum hydration, skin surface lipid, skin pH, and transepidermal water loss were unchanged from baseline levels. CONCLUSION: Salicylic acid peels are an effective and safe therapy for acne vulgaris in Asian patients.     

Lactic Acid Chemical Peels as a New Therapeutic Modality in Melasma in Comparison to Jessner''s Solution Chemical Peels

BACKGROUND: Many chemicals have been used in the skin peeling for melasma such as Jessner's solution and glycolic acid. Lactic acid is an alpha-hydroxy acid that has not been used before in chemical peeling of melasma. OBJECTIVE: The purpose of the present work was to evaluate the efficacy and safety of lactic acid in chemical peeling of melasma in comparison to Jessner's solution chemical peels. METHODS: This study was conducted at the Department of Dermatology and Venereology, Baghdad Hospital, in the period between April 2001 and August 2002. Thirty patients with melasma were included in this study. They were mostly of skin type IV according to Fitzpatrick's classification, 26 (86.67%) were women, and 4 (13.33%) were men, with an age range from 18 and 50 years (mean+/-SD, 33.53+/-6.96 years). Full clinical examination was done to all patients including Wood's light. The severity of melasma was assessed by MASI (Melasma Area Severity Index). Pure lactic acid full strength (92%, pH 3.5) was used as a new peeling agent on the left side of the face while Jessner's solution was applied to the right side of the face. The chemical peeling sessions were done every 3 weeks until the desired response was achieved. Follow-up was carried out for 6 months after the last session. RESULTS: Six patients were defaulted from the study after the first session for unknown reasons. Twenty-four patients completed the study. Twenty (83.33%) were women and four were men (16.67%). Wood's light examination showed increased contrast in all patients of mostly epidermal melasma. The number of sessions ranged from 2 to 5. All patients showed marked improvement as calculated by MASI score before and after treatment, and the response was highly statistically significant. No side effect was recorded in all treated patients. CONCLUSION: Lactic acid was found to be an effective and safe peeling agent in the treatment of melasma, and it was as effective as Jessner's solution.     

Efficacy of Alpha and Beta Hydroxy Acid Chemical Peels in Postacne Pigmentation: A Double Blinded,Randomized, Controlled Trial

BackgroundAcne is one of the most commonly faced dermatological complaints in our day-to-day practice. Among the various treatment modalities for acne and postacne pigmentation, chemical peeling is a promising and emerging treatment modality. Although various peeling agents are available, there is a lack of research comparing their efficacy. In addition, only a few studies have compared the efficacy of combined peels in the South Indian population. The present study aimed to compare the efficacy of alpha and beta hydroxy acid peels in the treatment of postacne pigmentation.MethodsForty patients with postacne pigmentation were divided into two groups of 20 patients each. Patients were randomized into one of the two treatment groups consecutively based on block randomization technique with block size 4. Patients of GA peel group was treated with 50% glycolic acid (GA) and the salicylic acid (SA) peel group was treated with 30% salicylic acid. The procedure was repeated every two weeks up to six weeks and the primary outcome was assessed every two weeks. The assessment with photographic documentation was done by a blinded evaluator from our department of dermatology.ResultsThe mean age of the study population was 21±2.29 years. Out of 40 patients, 24 were females and 16 were males. GA and SA peel groups showed significant improvement from first follow-up onwards in the study. However, GA peel showed higher percentage of postacne pigmentation reduction than SA peel in all the four follow-ups. In GA peel group, >75% reduction in postacne pigmentation was observed in 45 percent of the patients. Whereas in the SA peel group, none of the patients achieved >75% reduction of postacne pigmentation. Pairwise comparison between both groups were statistically significant (P<0.0001)ConclusionOur results suggest that the GA peel was more effective than SA peel in improving postacne pigmentation.     

Efficacy of Hydroquinone Cream (USP 4%) Used Alone or in Combination with Salicylic Acid Peels in Improving Photodamage on the Neck and Upper Chest

BACKGROUND: Salicylic acid, hydroquinone, and glycolic acid have been proved effective in the treatment of photodamaged facial skin. Few reports are available on the treatment of photodamage on the neck and upper chest. OBJECTIVE: This study's purpose was to evaluate the efficacy of a cream containing 4% hydroquinone and 2% glycolic acid (LUSTRA) used alone or with salicylic acid peels in reversing actinic damage on the neck and upper chest. METHODS: Nineteen women with moderate to advanced photodamage on the neck and upper chest applied a cream containing 4% hydroquinone and 2% glycolic acid twice daily on photodamaged areas for 12 weeks. Nine of these subjects had salicylic acid peels every 3 weeks. Improvements were assessed by the investigator, the subjects, and Mexameter readings measuring melanin and erythema levels. RESULTS: The result shows that there was a 33-71% improvement in photodamage, hyperpigmentation, texture, fine lines, dryness, tone, and clarity in both groups. There were no significant differences between the two treatments. CONCLUSION: Hydroquinone 4% cream with 2% glycolic acid is safe and effective in improving photodamage on the neck and upper chest when used alone or in combination with salicylic acid peels.     

Cardiac Complications in Deep Chemical Peels

BACKGROUND: Deep chemical peels have been used in dermatology for more than a century. The main indications for this procedure include photoaging, perioral wrinkling, acne scars, and precancerous skin lesions. The most important potential complication of deep peels is cardiotoxicity. OBJECTIVE: The objective was to estimate incidence of cardiac complications during full-face deep chemical peel and to suggest the methods to reduce the rate of this potential complication. METHODS: Clinical data on the patients being treated by full-face deep chemical peel between December 1, 2004, and November 30, 2005, were recorded. Full cardiomonitoring was performed during the peeling procedure. Any arrhythmia or medical intervention was recorded. RESULTS: A total of 181 patients have been treated during the study period. All the patients were female; the mean age was 56 years (range, 30-77 years). In 12 patients (6.6%), cardiac arrhythmia has been recorded during the procedure. Cardiac arrhythmia was more common in patients with diabetes, hypertension, and depression. In 4 patients the arrhythmia was self-limited and did not require any intervention. In the other 8 patients, 100 mg of lidocaine was given intravenously to control the arrhythmia. CONCLUSION: The incidence of cardiac complications in appropriately performed deep chemical peeling is lower than previously appreciated.     

Safety of Performing Superficial Chemical Peels in Patients on Oral Isotretinoin for Acne and Acne-Induced Pigmentation

BackgroundChemical peels are an integral part of dermatology practice for the treatment of acne, photoaging, and pigmentary dyschromias. Oral isotretinoin is considered the gold standard in the management of acne. Combining both is not currently recommended, due to the increased risk of complications like dryness, erythema, post-inflammatory hyperpigmentation, and scarring.ObjectiveWe sought to assess the safety and efficacy of superficial chemical peels in patients with acne taking isotretinoin and those not taking oral isotretinoin.MethodsA comparative, retrospective analysis of three superficial chemical peels was performed; the analysis included 60 patients and 214 sessions that took place between August 2017 and January 2018. Of these, 47 patients were on oral isotretinoin (Group A) and 13 were not on isotretinoin (Group B). In Group A, a salicylic acid-mandelic acid peel (SMP) was performed on 22 patients, a glycolic acid peel was performed on 18 patients, and a modified Jessner’s peel was performed on seven patients. In Group B, an SMP on eight, glycolic acid peel on four, and modified Jessner’s peel on one patient(s), respectively, were performed. Complications, if any, were noted, and incidence rates were compared by photographic assessment.ResultsOne patient in Group A and one patient in Group B had complications (persistent hyperpigmentation). The difference in the incidence of complications was insignificant between the two groups for all three superficial peels. Furthermore, it was noticed that patients in the isotretinoin group experienced faster and better improvement compared to those in the non-isotretinoin group.ConclusionIn our study, the use of isotretinoin did not result in any complications; hence, we encourage combination therapy to achieve enhanced and faster resolution of acne.     

Glycolic Acid Peels Compared to Microdermabrasion: A Right-Left Controlled Trial of Efficacy and Patient Satisfaction

BACKGROUND: Glycolic acid peels and microdermabrasion are widely recommended by dermatologists and others for facial skin rejuvenation, but few studies have assessed their clinical efficacy. OBJECTIVE: To compare the relative efficacy of glycolic acid peels and microdermabrasion for facial skin rejuvenation. METHODS: An unblinded, randomized controlled trial was used. Each of 10 patients received paired treatments with glycolic acid peels (20%) and microdermabrasion (mild setting) for 6 consecutive weeks. The right and left sides of the face were treated with different modalities. Once a patient was assigned to receive a particular modality to a particular side of the face, all subsequent treatments were delivered in the same manner. Patient ratings, investigator ratings, and photographs were obtained before the first treatment and 1 week after the last treatment. RESULTS: In terms of overall preference for a given type of treatment, seven patients chose glycolic acid peels, one selected microdermabrasion, and two had no favorite treatment. The relative preference for glycolic acid peels approached significance (P =.0578). Investigator ratings and photographic comparisons did not reveal treatment-specific differences or significant improvement from baseline. No serious side effects were seen with either treatment, and even mild effects were seldom reported. CONCLUSION: In this study, patients appeared to prefer low-strength glycolic acid peels to low-intensity microdermabrasion for facial rejuvenation. Differences in patient satisfaction were subtle and may be technique dependent.     

Tretinoin Peels versus Glycolic Acid Peels in the Treatment of Melasma in Dark-Skinned Patients

BACKGROUND: Chemical peels have become a popular method for treating melasma. Although daily topical 0.05 and 0.1% tretinoin have been used for melasma, the therapy takes at least 4 to 6 months to produce clinically significant lightening. In a recent trial, 1% tretinoin peel has shown good clinical and histologic results after biweekly applications in 2.5 weeks only in the treatment of melasma. OBJECTIVE: Because there is a paucity of studies evaluating the efficacy and safety of 1% tretinoin peel in the treatment of melasma in dark-skinned Asian population, we conducted a pilot study to evaluate the efficacy and side effects of this potentially new peeling agent versus a standard peeling agent, 70% glycolic acid, in the treatment of melasma in Indian women. METHODS: Ten female patients of melasma, after written consent, were taken up for an open left-right comparison pilot study of 12 weeks. One percent tretinoin peel was applied on one-half of the face, whereas 70% glycolic acid was applied on the other at weekly intervals. The results were evaluated by a clinical investigator by using the modified Melasma Area and Severity Index and with photographs at baseline and 6 and 12 weeks. RESULTS: A significant decrease in the modified Melasma Area and Severity Index from baseline to 6 weeks and then from 6 to 12 weeks was observed on both facial sides (p<0.001). Nevertheless, there was no statistically significant difference between the right and the left sides. Side effects were minimal and 1% tretinoin peel appeared to be well tolerated by the patients. CONCLUSIONS: It was concluded from the present trial that serial 1% tretinoin peel is a well tolerated and as effective a therapy for melasma in dark-skinned individuals as a standard and well-tried chemical peel, 70% glycolic acid, although larger trials over longer periods may be necessary to substantiate such findings.     

观察精准脉冲光(DPL)联合水杨酸治疗玫瑰痤疮的临床疗效及安全性

探讨玫瑰痤疮患者采取精准脉冲光联合水杨酸治疗的临床效果与安全性。方法 选取我院2022年8月-2023年5月收治的玫瑰痤疮患者84例为研究对象,随机分为对照组和观察组,各42例。对照组采取水杨酸治疗,观察组采取精准脉冲光联合水杨酸治疗,比较两组临床效果、不良反应发生率、面部皮损积分及生活质量。结果 观察组治疗总有效率为97.62%,高于对照组的76.19%（P ＜0.05）;观察组不良反应发生率为2.38%,低于对照组的16.67%（P ＜0.05）;观察组毛细血管扩张、丘疹、脓疱、瘙痒积分低于对照组（P ＜0.05）;两组治疗后生活质量评分低于治疗前,且观察组低于对照组（P ＜0.05）。结论 针对玫瑰痤疮患者,采取精准脉冲光联合水杨酸治疗的有效性及安全性较高,可有效改善患者皮肤状况,进而提升其生活质量。     

Safety and Efficacy of Poly-l-lactic Acid Injections in Persons with HIV-Associated Lipoatrophy: The US Experience

BACKGROUND: With the introduction of highly active antiretroviral therapy (HAART), HIV/AIDS has become a more chronic disease. This increase in survival, however, has been accompanied by the occurrence of metabolic and morphologic changes known collectively as HIV-associated lipodystrophy. OBJECTIVE: The objective was to evaluate the quantifiable improvement in facial wasting (lipoatrophy) after serial injections of poly-L-lactic acid (PLLA) as well as the long-term safety and durability of this material. METHODS AND MATERIALS: A single-site, open-label study in which patients received up to six treatment sessions of injectable PLLA. Patients were followed for 12 months after treatment. Patients were evaluated for increase in total cutaneous thickness by skin calipers. Serial photographs and patient satisfaction and patient well-being questionnaires were undertaken throughout the study period. RESULTS: Patients at the end of treatment exhibited a mean increase in skin thickness of 65.1% compared with baseline values. This correction was maintained throughout the 12-month follow-up period (68.8% at 6 months and 73% at 12 months). On a one to five scale, patient satisfaction was 4.5 at the end of treatment and increased to 4.8 at 12-month follow-up. No serious adverse events were reported. CONCLUSION: PLLA is a safe and well-tolerated treatment option for HIV-associated lipoatrophy.     

30%超分子水杨酸与低浓度甘醇酸在轻中度寻常性痤疮治疗中的疗效评价

目的:比较30%超分子水杨酸与低浓度甘醇酸治疗轻中度寻常性痤疮的疗效。方法:对2018年1月-2019年6月就诊于中国人民解放军总医院第一医学中心的86例轻、中度寻常性痤疮患者分别进行水杨酸或甘醇酸治疗,其中甘醇酸组48例,水杨酸组38例,共治疗3次,每次间隔时间2~3周,第1次治疗时、第2次治疗时、第3次治疗时及第3次治疗后4周随访(分别为V0、V1、V2、V3),记录患者痤疮分级、粉刺、炎性丘疹、脓疱、结节及GAGS评分。结果:V0时水杨酸治疗组粉刺17.00(13.00, 61.00)个、炎性丘疹32.00 (17.00, 67.00)个、 GAGS评分14.50 (14.00, 16.00)分;V0时甘醇酸治疗组粉刺24.50(11.00,44.00)个、炎性丘疹27.00(19.50,37.50)个、GAGS评分14.00(13.00,18.00)分。V3时水杨酸治疗组粉刺8.00(5.00,19.00)个、炎性丘疹20.00(10.00,22.00)个、GAGS评分11.00(9.00,13.00)分。V3时甘醇酸治疗组粉刺8.50(3.00, 21.00)个、炎性丘疹13.50 (10.00, 21.50)个、GAGS评分11.00 (9.50, 12.50)分。超分子水杨酸和低浓度甘醇酸两组间有效率及GAGS评分差异无统计学意义(P>0.05),两组内V3较V0皮疹减退率、有效率及GAGS评分差异均有统计学意义(P<0.05)。炎性丘疹方面甘醇酸组在治疗2次后较基线比差异有统计学意义,而水杨酸组在治疗3次后较基线比差异有统计学意义,两组治疗过程中均未出现明显不良反应。结论:30%超分子水杨酸与低浓度甘醇酸在轻中度寻常性痤疮治疗中均有效,在炎性丘疹治疗方面甘醇酸起效更快,但水杨酸的安全性略高。     

Pyruvic Acid Peels for the Treatment of Photoaging

BACKGROUND: Pyruvic acid (CH3-CO-COOH), an alpha-keto-acid, has been recently used as a medium chemical peeling agent in subjects with inflammatory acne, moderate acne scars, greasy skin, actinic keratosis, and warts. OBJECTIVE: The aim of our study was to evaluate the efficacy and tolerability of 50% pyruvic acid on moderately photodamaged facial skin. METHODS: We treated 20 patients with four peeling sessions at 4-week intervals. We evaluated the patients clinically, and in order to obtain an objective assessment of the effect of pyruvic acid on pigmentary components of the skin, erythema and hyperpigmentation response were measured in all the patients before and after treatment using a Minolta Tri-Stimulus Colorimeter II. RESULTS: The clinical evaluation of the patients after the peeling sessions demonstrated a smoother texture, less evident fine wrinkles, and evident lightening of hyperpigmentations (freckles and lentigines). In fact, chemical peels cause a thinning of the epidermis and a thickening of the dermis. The patients treated reported very limited or no discomfort in the postpeel period. CONCLUSION: Thus, 50% pyruvic acid peeling can be proposed as a safe and efficient treatment for moderate facial skin aging.     

Medium-Depth Chemical Peels in the Treatment of Acne Scars in Dark-Skinned Individuals

BACKGROUND: Multiple modalities are available for treating acne scars, one of which is chemical peeling. OBJECTIVE: To evaluate the efficacy of medium-depth peels in the treatment of acne scars. METHODS: A total of 15 patients (14 women and 1 man) were seen between November 1998 and March 2000. A medium-depth chemical peel was performed. The peel was performed using a combination of Jessner's solution followed by the application of 35% trichloroacetic acid (TCA). The mean age of patients who entered the study was 28 years. A total of 42 peeling sessions were performed: 13 patients had the full three-session regiment, 1 patient had two sessions, and 1 had only one session. RESULTS: Patients in our study had two forms of acne scars, the atrophic saucer or crater-like form and the pitted (ice-pick) form. Improvement occurred in all except one of our patients. Significant improvement (greater than 75% clearance of lesions) occurred in 1 patient (6.6%), moderate improvement (51-75% clearance) in 8 patients (53.3%), mild improvement (26-50% clearance) in 4 patients (26.6%), minimal improvement (1-25% clearance) in 1 patient (6.6%), and no response in 1 patient (6.6%). All patients had different combinations of the above two forms. Four patients (26.6%) had mainly pitted scars and deep atrophic scars. The clinical response in those patients was moderate, mild, minimal, and no response, respectively. The remainder of our patients had mainly atrophic scars of moderate depth. Nine patients (73.4%) suffered from transient postinflammatory hyperpigmentation. In two of them it was preceded by erythema that lasted for more than 1 month. All patients were free of noticeable pigmentation 3 months after the final peel. Patients in whom hyperpigmentation did not develop were of light brown complexion. CONCLUSION: We conclude that medium-depth chemical peel is a safe and effective method of treating acne scars even in patients with dark complexion.     

Safety and Efficacy of Nonanimal Stabilized Hyaluronic Acid for Improvement of Mouth Corners

BACKGROUND: Esthetic concern with downturned mouth corners ("mouth frown") is increasing in the aging baby-boomer generation. A new technique to offer structural support using the recently approved filler nonanimal stabilized hyaluronic acid (NASHA; Restylane, Q-med Inc., Uppsala, Sweden) is described. METHOD: Fifteen women with prominent downturned mouth corners met the inclusion criteria for the study. All were photographed before and at 1 week, 3 months, 4.5 months, and 6 months after treatment using a standardized clinical photographic system. NASHA was injected using a standardized technique with nerve block anesthesia to ensure patient comfort. RESULTS: All 15 women noted swelling, redness, and some local discomfort for several days after the injection. All noted an improvement in the downward angulation of their mouth corners at the first post-treatment visit, with at least partial improvement maintained through the 6-month post-treatment follow-up visit. CONCLUSIONS: NASHA injection to support the age-related downturn of lateral lip corners was effective, safe, and well tolerated in a small prospective study of middle-aged female subjects. Esthetic satisfaction was greatest in the first 3 months post-treatment, but 40% of subjects still noted improvement at the 6-month follow-up visit.